Next steps: it’s up to you (and us, and others!)
The 3rd Rural and Remote Health Scientific Symposium resulted in five research proposals that, if funded, would help address some critical challenges for rural health and wellbeing. Each of the proposals can be related to other contemporary health research issues, such as those relating to rural health service design, workforce distribution, and data and information systems.
Individuals and agencies that were not able to be at the Symposium are encouraged to throw their support behind one or more of the research proposals outlined in the Summary.
The nominated person(s) for each of the proposals has agreed to take on the lead responsibility for further development of the proposals and, hopefully, for the successful funding and prosecution of them.
Please contact the nominated person if:
- you would like to be involved in further development of the proposals – as a researcher, community member, interested stakeholder, funder, health system, industry or government collaborator;
- you have a suggestion of a person or organisation that you think they should contact;
- you are aware of any completed work or existing activity that is relevant to the proposal; or
- you know of any funding opportunities that seem relevant to one or more of the proposals.
The Alliance can assist you in making contact ([email protected])
The basic criteria for the collaborative proposals remain:
- those who are expected to benefit should be a part of the collaboration from this early stage; and
-
the research should address issues that are
- not known/not well understood,
- important and relevant, and
- researchable.
Thank you to the Steering Group and all Symposium participants for their ongoing contributions.
Summary of the research proposals
Topic 1A: demographic change and rural health service design
Topic 1B: involving rural and remote communities in Medicare Locals
Topic 2A: enhancing disaster recovery and resilience in rural and remote communities
Topic 2B: weather related disasters, other adversities and mental health
Topic 3: The impact of culture on rural health and health services
a. Changing mainstream health services
b. Teaching and our future health professionals
c. Societal level understandings of culture and whiteness
Topic 1A: demographic change and rural health service design
This program of research relates to health service design for rural and remote areas, with Medicare Locals as a potential spatial focus; demographic change and responsiveness/hyper-flexibility of service systems; Fly-in Fly-out (FIFO) models; telehealth and more.
It has been agreed that the first step in this work will be a scoping exercise on who is doing what in the area, including geographers and health economists as well as rural health researchers. Key activities already suggested for consideration include the States’ rural health plans; rural birthing index (and general rural health service index approaches); work by the Centre for Research Excellence in accessible and equitable primary care service provision in rural and remote Australia, and other related work in the University Departments of Rural Health.
After the scoping phase and liaison with interested parties (including Health Departments), this collaborative research area might well consider access and service design issues against income and other information (eg geography, demography) to provide a clearer picture of how governments can better prioritise provision of health services, to get beyond the ‘one size fits all rural’ approach. It could be broadened to deal with primary health care and consider the relationships between the social determinants of health and sustainable and healthy communities. Specific issues could include successful and less successful service models based on ‘fly in-fly out’ workforces and services.
Interested: Lesley Barclay, Lisa Bourke, Dean Carson, Jennene Greenhill, Rafat Hussain, Bill Adam, Jennifer Critchley, Rebecca Evans, Karen Francis, Jeff Fuller, Matt Haren, Virginia Hart, Desley Hegney, Sarah Larkins, David Lyle, Matthew McGrail, Julia Marley, Lee Martinez, Daryl Mayberry, Geoff Morgan, Matthew Murphy, David Perkins, Dianne Rudd, Peter Smailes, John Wakerman, Bob Wells and the National Rural Health Alliance.
The Alliance will continue to provide policy and administrative support to this group, including through follow-up with potential industry, Government and community stakeholders, such as the Australian Governmment Department of Health and Ageing and State/Territory Health Departments, FaHCSIA, Medicare Locals, Rural Development Australia Committees, PHCRIS, Medicare Local and Local Hospital/Health Network representatives, and consumer representatives. The Alliance can also assist by pursuing the potential for the agreed NHMRC Partnership Centre theme on access to primary care to have a very strong focus on access in rural and remote areas.
Topic 1B: Involving rural and remote communities in Medicare Locals
This proposal is about the means by which Medicare Locals involve, consult and communicate with their local community, including on health service planning, ‘service gap-filling’, and measuring progress (including through their Healthy Communities reports). It will consider the characteristics of rural health service systems that enable them to meet the needs and beliefs of the diverse populations in rural and remote areas; and the best practice approaches to such involvement.
This work is related to Topic 1A and consideration is being given to how the two should progress together or in tandem.
Interested: David Atkinson, Jane Farmer, Tony Lower, Anne McKenzie, Dee McLaughlin, and Megan Passey.
Topic 2A: Enhancing disaster recovery and resilience in rural and remote communities
This proposal is for a comparative study of disaster-affected rural and remote communities in Australia, inquiring into the social production of disaster recovery and resilience, through applied research in rural and remote communities. It is designed to analyse the interactions between government, health and non-government services and communities during recovery efforts and their influences on the capabilities of disaster-affected individuals. The goal of this research is to advance knowledge on sustainable disaster recovery practices, improve the ability of agencies to conduct their activities to enhance disaster resilience, and develop a conceptual framework to empower local communities and individuals to selectively focus attention and resources on strategies to overcome or circumvent barriers to change.
Interested: David Atkinson, Jane Farmer , Karen Francis, Desley Hegney, Sharon Kelleher, Brett McDermott, David Perkins, and Prasuna Reddy.
Topic 2B: Weather-related disasters, other adversities and mental health
What is it that enables different rural/remote sub-populations facing common environmental adversities to respond with varying degrees of resilience and functionality? How are these distinguishing characteristics related over time to the mental health and resilience of these sub-populations and the communities in which they live?
Interested: Helen Berry, Jennifer Bowers, Sophie Dwyer, Brett McDermott.
Topic 3: The impact of culture on rural health and health services
Background to the three sub-topics
Following the Symposium, some overarching questions were canvassed with participants:
- By what means can rural health practitioners be better enabled to recognise the way in which ‘culture’ impacts on the design of the system in which they work and the way in which, as individuals, they operate?
- How much and in what ways do ‘culture’ and perceptions of culture determine resistance to change, and what do good practice change models for overcoming such change look like?
- Are there case studies of successful organisational change in small health services or clinics, regional hospitals and other settings?
- How can the education and training of health professionals maximise understanding of culture and practitioner or system flexibility, and ensure effective trans-cultural care?
There was a strong preference for retaining the three research projects as conceived at the Symposium, as follows.
3a: Changing mainstream health services
Research topics:
- What are good practice change models (case studies, documentation, led from the top)?
- Intervention – welcoming to all cultures, small services (clinics, regional hospitals), improving access, simple changes (culturally safe), change people’s behaviours – resistance to change.
- Systems are the issue, not just clinicians.
Next steps: David Atkinson, Julia Marley, Peter McKeown and others in the group
3b: Teaching and our future health professionals
Health professional education as enculturation.
- The hypothesis is that, in many places, this is not being done as well as it could be.
- The specific issue is whether there are rural-metropolitan differences.
Next steps: Bill Adam, Karen Francis, Jennene Greenhill, Desley Hegney, Peter McKeown, Dee McLaughlin, Sarah Larkins, Jane Mills and Megan Passey.
3c: Societal level understandings of culture and whiteness
Research topic: Is scientific expertise an impediment to trans-cultural care?
Aims and objectives:
1. How does science become authoritative expertise?
2. How can ‘transcultural care’ (as defined by cultural studies) be managed?
3. Changing use of science and use of cultural knowledge (own and others)
4. How modernisation and progress become embedded in science
Next steps: Jenny Baker, Lisa Bourke, Jennifer Critchley, Rafat Hussain, John Nyagua and Judy Taylor.
Lisa Bourke has sent an email to the group seeking their ongoing interest, ideas on how to progress and suggesting a paper as a first step.